Delicate Dance for 2 Lobbyists on Health Bill

SHERYL GAY STOLBERG

Wednesday

Oct 28, 2009 at 5:10 AM

Billy Tauzin and Karen Ignagni, the odd couple in the health care debate, are fighting for their industry clients.

WASHINGTON — One is a smooth-talking former congressman from Louisiana — “the Swamp Fox,” constituents called him — who relishes his image as a rascal, a charmer and a Cajun raconteur. The other is a fireman’s daughter from working-class Rhode Island, strait-laced and studious, who mastered the arcane world of health policy as an analyst for the A.F.L.-C.I.O.

As perhaps the two most powerful health industry lobbyists in Washington, the two of them, Billy Tauzin and Karen Ignagni, are the odd couple of the capital’s health care debate. Their paths are as opposite as their personalities.

Mr. Tauzin, a Democrat turned Republican, is the chief lobbyist for drug makers. After cutting an $80 billion, 10-year deal for his industry — blessed by the White House — to help pay for a health care overhaul, he is now working quietly to keep his pact from unraveling on Capitol Hill.

Ms. Ignagni, a Democrat who represents insurers, stood up at the White House in March and told President Obama he had her “commitment to play, to contribute and to help pass health care reform this year.”

Now, a day after losing a critical battle to keep a new government insurance plan out of the Senate health bill, she is fighting to persuade official Washington she meant what she said, as Mr. Obama, a man she says she voted for, accuses her industry of waging a “smoke and mirrors” campaign to undermine reform.

The story of these two lobbyists — a Republican who found favor with a Democratic White House and a Democrat on the outs — illustrates the complexities Mr. Obama faces in the health care endgame. The president had some early success in bringing industry on board. But as the experiences of Mr. Tauzin and Ms. Ignagni suggest, keeping it there will be easier said than done.

“There are very different industry dynamics here,” said Representative Jim Cooper, Democrat of Tennessee, who teaches health policy at Vanderbilt University. “The basic deal for these two industries, and others, is that they promised to behave if they get 40 million new customers. But now they are seeing they might not get as many new customers, and they are wondering if they still have to behave.”

Ms. Ignagni worked her way up the trade association ladder, becoming head of America’s Health Insurance Plans in 2003 after two smaller groups merged. Mr. Tauzin was hired to run the Pharmaceutical Research and Manufacturers of America five years ago, after helping pass an industry-friendly Medicare prescription drug bill. Even by the eye-popping standards of K Street, they are well paid; in 2007, the most recent year for which figures are available, Mr. Tauzin earned more than $2 million; Ms. Ignagni, $1.6 million.

With insurers blaming drug makers for high prices and drug makers blaming insurers for scanty coverage, the two association chiefs have a kind of kind of trust-but-verify relationship.

“Clearly, they have a healthy respect for each other,” said Ken Johnson, Mr. Tauzin’s longtime spokesman. (Mr. Tauzin would not be interviewed.) Ms. Ignagni calls her drug industry counterpart “a wonderfully affable man.”

Washington is full of stories about Mr. Tauzin’s affability. Some people talk about his youthful side career as an actor (“He put the ‘ham’ in Hamlet,” one associate said jokingly.) Others recall him regaling Ronald Reagan with Cajun jokes. Then there was his near-fatal bout with stomach cancer in 2004, an experience that turned Mr. Tauzin into a walking salesman for the pharmaceutical industry.

“I visited him in the hospital and told him I was going to pray for him,” John Breaux, the former Louisiana senator, recalled. “He said: ‘No, no, don’t do that. I want somebody with better connections.’ ”

More than being affable, however, Mr. Tauzin is also wily — “as wily as any alligator in the swamp,” Mr. Cooper said. One story that has people in Washington talking is about how he positioned his industry so masterfully once he got inside the White House door, a door that, Ms. Ignagni helped open.

With her union roots and Democratic pedigree (she once worked as an aide to Senator Claiborne Pell of Rhode Island), Ms. Ignagni faces suspicion from liberals who accuse her of jumping to “the dark side.” She sees nothing unnatural about it. She worked with insurers to preserve union health benefits, she said, and is still working to do that today.

Some critics call her a phony. “She puts on this veneer of caring,” said Richard Kirsch, who runs Health Care for America Now, an advocacy group. But another advocate, Ron Pollack of Families USA, senses conflict between Ms. Ignagni and the companies she represents.

“I think Karen personally wants very much to get to yes,” Mr. Pollack said.

Ms. Ignagni has a policy wonk’s passion for statistics and a chess player’s eye for looking around corners. As early as 2006, she told her member companies that universal coverage — the initiative they helped kill when Bill Clinton was president — was headed back to the national agenda, and that it was time for them to get on board.

“One of her great strengths is that she tends to look where the puck is going to be,” said James Roosevelt Jr., the chief executive of Tufts Health Plan.

This spring, Ms. Ignagni tried to initiate talks with Nancy-Ann DeParle, head of the White House Office of Health Reform, working through a union leader, Dennis Rivera. Ms. DeParle was skeptical, said a senior White House official who insisted on anonymity to discuss internal conversations. She insisted that hospitals, doctors and drug makers be included in any talks.

“Karen said, ‘We’ll never be able to get Billy Tauzin to come,’ ” the official recalled.

But Mr. Tauzin, this official said, was “very aggressive in wanting to be at the table.” One result was the $80 billion deal with the Senate Finance Committee, and the White House’s assent. For the industry, health reform is a chance for millions of new customers.

Now Mr. Tauzin’s task is to keep that deal intact, as Democrats like Representative Henry A. Waxman of California, an architect of health legislation in the House, seek to reopen it. “He’s certainly getting a good deal for his industry,” Mr. Waxman said, “but I don’t think it’s a good deal for the American people.”

Ms. Ignagni offered her own package of concessions, including covering people with pre-existing conditions, ending lifetime coverage caps and simplifying record-keeping, all the while fighting the “public option,” as a government plan is known. She insists her companies are still committed to passing a health care overhaul this year.